First - facts from the history of our nations

In 1775 Russia twice refused to support Great Britain in the war against USA and in 1780 announced total neutrality toward USA In 1863 Russia in order to help USA (North) sent 2 navy ships to block British and French trade shipping's

During 1942-1944 the proportion of medicines from USA (land lease) composed over 70% from all their consumption in USSR in tons/ Plus 700 000 syringes were sent from USA (USSR Health Ministry data) 72,4%

During 1942-1944 the proportion of medicines from USA and UK (land lease) complied over 70% from all their consumption in USSR in tones (USSR Health Ministry data) Names of drugs Produced in USSR 1942-1944 (tons) Supplied by the USA and UK 1942-1944 (tons) Rate from all consumption, % Сaffein 10,05 36,1 78% Luminal 1,09 33,3 97% Aspirin 111,8 128,5 53,5% Phenacetin 0,6 47,9 98,8% Sulphanilamide 295 270 47,8% Medical glucose 275 547,2 66,6% Kovarsenol 0,79 0,8 50% Potassium bromide 15,3 107,1 87,5% Average 72,4%

Thanks to this support from USA during II World War 7 mln Soviet citizens 15 mln Soviet soldiers and officers got adequate medical care OUR NATIONS HISTORICALLY HAVE WARM MUTUAL TIES!

Land-lease – Studebakers were full of food from American citizens

HEALTHCARE IN RUSSIA: HOW TO REACH LIFE EXPECTANCY 76 YEARS Head of the Graduate School for Healthcare Organization and Management Chair lady of the Russian Society for Quality in healthcare and education Guzel ULUMBEKOVA, MD, PhD

The goal for healthcare system is set Life expectancy at birth should grow to 76 years to the year 2025 Orders’ list of the President of the Russian Federation from 02.04.2017 №Пр-589 (http://kremlin.ru/acts/assignments/orders/54266)

1. CHALLENGES IN POPULATION HEALTH AND FACTORS AFFECTING IT TODAY. Russia, EU, USA and Canada

With whom Russia can be compared? – with «new-8» EU countries

Life expectancy at birth (LEB) in Russia is growing, but by 5 Life expectancy at birth (LEB) in Russia is growing, but by 5.7 years lower than in «new-8» EU countries

Life expectancy at birth, males, in Russia is increasing, but by 7 Life expectancy at birth, males, in Russia is increasing, but by 7.2 years lower than in «new-8» EU countries

Infant mortality rate in Russia is decreasing, but is 1 Infant mortality rate in Russia is decreasing, but is 1.5 times higher than in «new-8» EU countries Change of criteria

Mortality rate at the age 0-14 in Russia is decreasing, but still 2 times higher than in «new-8» EU countries

Factors affecting population health Life expectancy Health care expenditures Personal behaviors Public health programs GDP per capita

Alcohol consumption at the age over 15 in Russia is by 10% higher than in «new-8» EU countries

Tobacco consumption at the age over 15 in Russia is 9% points higher than in «new-8» EU countries

Russian public spending on healthcare per capita was 1 Russian public spending on healthcare per capita was 1.6 times lower than in «new-8» EU countries (2016)

In Russia LEB directly depends on the healthcare expenditures from 400 to 1700 $PPP

Public expenditure on pharmaceuticals per capita per year in Russia is 3.7 times lower than in «new-8» EU countries

2 HEALTHCARE EFFICIENCY Efficiency is always a comparison of outcomes toward recourses spend

What countries are included into Bloomberg efficiency rank? LEB > 70 years Population > 5 mln GDP > US$ 5 000 per capita Number of countries in the rank – 55 Rank from 1 to 55

How the points are scored Higher LEB 83,83 years max scores – 48 70,45 years min scores – 1,17 Min. health expenditures 264 $PPP per capita or 3,2% GDP max scores – 32 9 715 $PPP per capita or 17,1% GDP min scores – 0,78

Best 10 countries in healthcare efficiency

Worst 10 countries in healthcare efficiency

These are the regions of the Russian Federation by healthcare efficiency, 2015 (expenditures are divided by differentiation index)

CONCLUSIONS AND WHAT WE CAN LEARN FROM OTHER HEALTHCARE SYSTEMS 3. CONCLUSIONS AND WHAT WE CAN LEARN FROM OTHER HEALTHCARE SYSTEMS

Conclusions (results) Population health status in Russia is worse than in new EU countries – LEB is 5.7 years lower The most dramatic difference in LEB is for men – is 7.2 years lower than in “new” EU Children mortality in Russia is 2 times higher, Infectious diseases mortality is 4.1 times higher, than in “new” EU

WHY? Alcohol and tobacco consumption is higher than in EU, USA and Canada Public healthcare spending is 1,5 times less than in “new” EU countries Healthcare financial resources are not directed on priorities (primary care and pharmaceuticals) and can be used more efficiently

Advantages of Russian healthcare system Healthcare is one of Government priorities Centralized regulation Tradition in planning care volumes and resource Gatekeeping and coordination of care Government initiated centralized IT system implementation in healthcare

Lessons from the USA Strong public health programs Home care for elderly, long term care programs Patient centered programs Quality improvement and patient safety programs in hospitals Operational efficiency increasing programs New healthcare providers payment systems CME and lifelong learning for physicians Excellent MBA programs for doctors (Harvard Chan School of Public Health MHCM program)

Logic models in public healthcare

Scientific and research background USA - scientific approach for Healthcare Strategy Development “Healthy People 2020”. The work on HP 2030 is doing and will take 3 years https://www.healthypeople.gov/2020/About-Healthy-People/Development-Healthy-People-2030 US Government US Department of health and human services Federal Interagency Workgroup Secretary’s Advisory Committee – Chair and 12 experts Different federal Agencies and scientific institutes Scientific and research background FORMING STRATEGY GOALS, PRIORITIES, TARGET INDICATORS, RECOMMENDATIONS FOR DEVELOPMENT

PRIORITIES FOR THE FUTURE in RUSSIAN HEALTHCARE 5. PRIORITIES FOR THE FUTURE in RUSSIAN HEALTHCARE

2 blocks in Healthcare Development Strategy till 2025 1. Comprehensive Program for the public health protection 2. Healthcare system – increasing the quality and accessibility of medical care Responsivity of state and municipal governments Responsibility of healthcare system Plan of activities

1 block — reducing alcohol and tobacco consumption, active sports, involving employers – programs at the municipality level

2 block – accessibility and quality of medical care Main focus – taking care of health of Russian men of Russian children and adolescents

Priorities for healthcare expenditures Accessible primary care and medicated prevention Medical and social care for the citizens of the older age group at home The increase in the prescribed outpatient drugs supply Efficiency and prudence in the use of resources We can calculate efficiency

That is all impossible without well qualified medical personnel, educated healthcare leaders and informatization Healthcare informatization Continuing professional development of health professionals Doctor’s adviser – “Artificial Intelligence”

Special programs in Oncological diseases treatment Infectious diseases treatment Based on evidence based approach cost-efficiency calculations developed by opinion leaders discussed nationally with interested parties

Thank you for attention! MISSION OF GRADUATE SCHOOL FOR HEALTHCARE ORGANIZATION AND MANAGEMENT: «High quality of medical care through efficient healthcare management» www.vshouz.ru тел. +7 (495) 662-80-96 +7 (985) 278-92-35 e-mail: vshouz@vshouz.ru